SOHO 2024 | Advances in Hodgkin lymphoma treatment: moving away from ABVD and BEACOPP

It’s very interesting. It’s a time when things are changing a lot in Hodgkin lymphoma. It’s really a good thing because for many years we did very similar things, but what used to be was a strategy of either low intensity treatment like ABVD, intensifying in a subset of patients, compared to starting with an intense regimen like escalated BEACOPP, and then decreasing the number of cycles to minimize toxicity. Over the last number of years, the use of brentuximab vedotin and the use of PD-1 blocking antibodies like nivolumab have really moved all the way to frontline therapy. So two major recent studies have now been read out and are really challenging how we’re thinking about managing patients. The first is a comparison of BrECADD, which is a modified escalated BEACOPP with the use of brentuximab vedotin compared to escalated BEACOPP. And that showed that you can decrease the intensity and actually get better results. And then on the other hand, ABVD chemotherapy was really kind of replaced by brentuximab vedotin-AVD chemotherapy. And then that combination was compared to nivolumab-AVD chemotherapy, we’re showing that the PD-1 AVD treatment is really probably preferred in most patients. So we’re now at the place where we have new treatments that are even more effective and toxicities are even less. So the question I was asked is, can we dispense with the old? And the answer is largely yes. The challenge for the future though is what to do comparing nivolumab-AVD and BrECADD, and that’s going to take a randomized trial.